Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | MD060054L | PA |
NPI | 1013985746 |
---|---|
Provider Name | Patricia Ellen Riley |
First Address | Clarksboro, NJ 08020-1145 |
Second Address | Newtown Square, PA 19073-1810 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2006 |
Last Update Date | 27/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001726304 | (05) | PA |
G74630 | (02) |